While the world is still struggling with the challenges posed by COVID pandemic, a new type of highly contagious disease called monkeypox has started spreading throughout the world. Bangladesh authorities should take immediate measures in monitoring each of the travelers arriving from African countries in particular in order to stop spread of this virus in the country. It has also been reported in the media that people in some of the Middle Eastern countries are already diagnosed being infected by monkeypox virus, meaning, Bangladesh authorities also need to take effective measures in bringing travelers from these countries under radar.
As monkeypox also spreads through places infected people had touched, airline companies need to take immediate measures for disinfecting each of the seats in particular after every flight.
Good news is, there already is medicine for combating this virus. The vaccine is approved under the brand name Jynneos in the United States with a label that also specifically covers monkeypox. Because monkeypox virus is closely related to the variola virus that causes smallpox, smallpox vaccines can also protect against monkeypox. But it does not mean we can ignore this highly contagious virus, because, according to health experts, this is an unusual and unprecedented monkeypox outbreak. It has taken scientists who specialize in the disease by complete surprise and it is always a concern when a virus changes its behavior.
The Massachusetts Department of Public Health and the Centers for Disease Control and Prevention (CDC) are investigating a confirmed case of monkeypox in the United States. Cases of monkeypox have previously been identified in travelers from, or residents of, West African or Central African countries where monkeypox is considered to be endemic.
Since May 14, 2022, clusters of monkeypox cases, have been reported in several countries that don’t normally have monkeypox. Although previous cases outside of Africa have been associated with travel from Nigeria, most of the recent cases do not have direct travel-associated exposure risks. The United Kingdom Health Security Agency (UKHSA) was the first to announce on May 7, 2022, identification of a recent UK case that occurred in a traveler returning from Nigeria. On May 14, 2022, UKHSA announced an unrelated cluster of monkeypox cases in two people living in the same household who have no history of recent travel. On May 16, 2022, UKHSA announced a third temporally clustered group of cases involving four people who self-identify as gay, bisexual, or men who have sex with men (MSM), none of whom have links to the three previously diagnosed patients. Some evidence suggests that cases among MSM may be epidemiologically linked; the patients in this cluster were identified at sexual health clinics. This is an evolving investigation and public health authorities hope to learn more about routes of exposure in the coming days.
Monkeypox is a zoonotic infection endemic to several Central and West African countries. The wild animal reservoir is unknown. Before May 2022, cases outside of Africa were reported either among people with recent travel to Nigeria or contact with a person with a confirmed monkeypox virus infection. However, in May 2022, nine patients were confirmed with monkeypox in England; six were among persons without a history of travel to Africa and the source of these infections is unknown.
Monkeypox disease symptoms always involve the characteristic rash, regardless of whether there is disseminated rash. Historically, the rash has been preceded by a prodrome including fever, lymphadenopathy, and often other non-specific symptoms such as malaise, headache, and muscle aches. In the most recent reported cases, prodromal symptoms may not have always occurred; some recent cases have begun with characteristic, monkeypox-like lesions in the genital and perianal region, in the absence of subjective fever and other prodromal symptoms. For this reason, cases may be confused with more commonly seen infections (e.g., syphilis, chancroid, herpes, and varicella zoster). The average incubation period for symptom onset is 5–13 days.
The typical monkeypox lesions involve the following: deep-seated and well-circumscribed lesions, often with central umbilication; and lesion progression through specific sequential stages—macules, papules, vesicles, pustules, and scabs. Synchronized progression occurs on specific anatomic sites with lesions in each stage of development for at least 1–2 days. The scabs eventually fall off1. Lesions can occur on the palms and soles, and when generalized, the rash is very similar to that of smallpox including a centrifugal distribution. Monkeypox can occur concurrently with other rash illnesses, including varicella-zoster virus and herpes simplex virus infections. Case fatality for monkeypox is reported to range between 1 and 11 percent.
Confirmatory laboratory diagnostic testing for monkeypox is performed using real-time polymerase chain reaction assay on lesion-derived specimens.
A person is considered infectious from the onset of symptoms and is presumed to remain infectious until lesions have crusted, those crusts have separated, and a fresh layer of healthy skin has formed underneath. Human-to-human transmission occurs through large respiratory droplets and by direct contact with body fluids or lesion material. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required. Indirect contact with lesion material through fomites has also been documented. Animal-to-human transmission may occur through a bite or scratch, preparation of wild game, and direct or indirect contact with body fluids or lesion material.
According to experts, in UK, the first time the monkeypox virus is being found in people with no clear connection to Western and Central Africa. It is not clear who people are catching it from.
Monkeypox is spreading during sexual activities with most cases having lesions on their genitals and the surrounding area.
Many of those affected are gay and bisexual young men.
“We’re in a very new situation, that is a surprise and a worry”, Prof Sir Peter Horby, the director of the University of Oxford’s Pandemic Sciences Institute, told BBC.
While he says this is “not COVID-Two”, he said “we need to act” to prevent the virus getting a foothold as this is “something we really want to avoid”.
Dr Hugh Adler, who has treated patients with monkeypox, agrees: “It’s not a pattern we’ve seen before – this is a surprise”.
We know this outbreak is different, but we don’t know why.
There’s two broad options – the virus has changed or the same old virus has found itself in the right place at the right time to thrive.
Monkeypox is a DNA virus so it does not mutate as rapidly as COVID or flu. Very early genetic analysis suggests the current cases are very closely related to forms of the virus seen in 2018 and 2019. It is too early to be sure, but for now there is no evidence this is a new mutant variant at play.
But a virus doesn’t have to change in order to take advantage of an opportunity, as we have learned from unexpected large outbreaks of both Ebola and Zika virus in the last decade.
“We always thought Ebola was easy to contain, until that wasn’t the case,” said Prof Adam Kucharski, from the London School of Hygiene and Tropical Medicine.
It’s not clear why gay and bisexual men are disproportionately affected. Are sexual behaviors making it easier to spread? Is it just coincidence? Is it a community that is more aware of sexual health and getting checked out?
It may also be getting easier for monkeypox to spread. The mass smallpox vaccinations of the past would have given older generations some protection against the closely related monkeypox.
“It is probably transmitting more effectively than in the smallpox era, but we’re not seeing anything suggesting it could run rampant”, said Dr Adler, who still expects this outbreak to burn itself out.
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